Table of Content

25 January 2016, Volume 25 Issue 1

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The application of macular ganglion cell-inner plexiform layer thickness measured by spectral-domain optical coherence tomography in early glaucoma diagnosis 

LIU Xing, XU Xiao-yu.

2016, 25(1):  1-5.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 001

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Macular ganglion cells-inner plexiform layer (GCIPL) thickness detected by SD-OCT may be a better method than peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC) for earlier diagnosis of glaucomatous damage. GCIPL in  superonasal sector is the thickest while GCIPL in inferior sector is the thinnest in Asian population. Age and the axial length are important impact factors of GCIPL thickness. GCIPL thickness has similar glaucoma distinguishing performance with RNFL thickness. Mutual integration of visual field testing, GCIPL thickness, RNFL thickness and optic disc parameters is the key to enable early detection of glaucoma. (Ophthalmol CHN, 2016, 25: 1-5)

Glaucoma opportunistic screening in patients with myopia

LI Jian-jun, XU Liang

2016, 25(1):  6-8.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 002

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Youngsters myopia prevalence in China is currently showing a trend of increase with the age growth, younger age of onset and more refractive degree. Myopia, especially in high myopia is a risk factor for the prevalence and progression of primary open angle glaucoma (POAG). It is more difficult to diagnose and detect progression of POAG in patient with high myopia combined with POAG. Therefore, we should pay more attention to perform opportunistic screening for glaucoma in myopia patients during examination in hospital including optometry, in which the fundus photography and the establishment of personal health records and the image database on a cloud based platform is a good screening and follow-up method. (Ophthalmol CHN, 2016, 25: 6-8)

Analysis of disease types in videoconferencing-based teleconsultation of Beijing Tongren Eye Center 

LIU Li-juan1, LI Jian-jun1, WU Qu2, LU Cong-lei3, WANG Shuang1, DUAN Xin-rong1, DENG Shi-jing1, ZENG Hui-yang1, ZHANG Li1, SHI Xiang-yu1, AI Li-kun1, WANG Li-bo3, XU Liang1.

2016, 25(1):  9-12.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 003

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Objective To explore the disease constitution ratio of remote video consultation in teleophthalmology of Beijing Tongren Eye Center. Design Retrospective case series. Participants From January 1, 2014 to October 30, 2015, 354 cases of video consultation for teleophthalmology from 35 primary hospitals were reviewed in Beijing Tongren Eye Center, whose average age was 45.5±19.5 years-old. Methods The tele-medical software system based on cloud platform developed by Beijing Institute of Ophthalmology and Beijing Daheng Prust Company was used for remote reading and evaluation of ocular fundus images, and then Cisco WebEx Meeting video conferencing system was used for the appointment and video consultation. The remote video consultation records were exported from Daheng Prust remote reading database software, with the software of Excel and SPSS for statistical classification of diseases. Main Outcome Measures The disease constitution ratio of patients of remote video consultation. Result  In all 354 case, anterior ischemic optic neuropathy and other optic disc edema of single eye was 32 cases (9.04%), secondary glaucomas was 21 cases (5.93%), retinal vein occlusion was 20 cases (5.64%), proliferative diabetic retinopathy was 15 cases (4.24%), primary open angle glaucoma and its complications of after filtering surgery was 14 cases (3.95%), panuveitis was 12 cases (3.39%), decreased visual acuity of unknown origin 12 cases (3.39%), vitreous hemorrhage was 10 cases (2.82%), age-related macular degeneration was 9 cases (2.54%), central serous chorioretinopathy 8 cases (2.26%), epiretinal membranes of the macula was 8 cases (2.26%), pathological myopia and its complications was 7 cases (1.98%). Conclusion In current video tele-consultation, monocular optic disc edema, secondary glaucoma, retinal vein occlusion and proliferative diabetic retinopathy are most demand for diagnosis and treatment of teleophthalmopathy in Chinese primary hospitals. (Ophthalmol CHN, 2016, 25: 9-12)

The timeliness of the image reading and the description details of the reading reports in teleophthalmology 

LI Jian-jun1, XU Liang1, LU Cong-lei2, WU Qu3, WANG Li-bo2, LIU Li-juan1, WANG Shuang1, SUN Xiu-ying1, LIANG Jian-yi1.

2016, 25(1):  13-17.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 004

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Objective To investigate the timeliness of the image reading and the description details of the reading reports in teleophthalmology. Design Retrospective case series. Participants  7713 cases of patients in the teleophthalmic image reading center of Beijing Tongren Hospital in December 2015. Methods The reading report data was exported as Excel file format with Daheng Prust cloud medical system software. The time between the basic hospital upload image data and the remote access to read and give the report by a doctor was calculated with the software. The number of words of “image description of ocular fundus” and “treatment recommendations” were calculated with LEN function of Excel software. Statistical analysis was performed with SPSS13.0 software. Main Outcome Measures The timeliness of the image reading, the number of words of “description of ocular fundus image” and “treatment recommendations”. Result The median time of getting reading report from the image reading center was 55 minutes ( percentile 25%~75%: 18~118 minutes) in 7713 patients. 35.3% of the patients got the results of the image reading within 30 minutes, and 91.5% within 4 hours. The number of words of “description of ocular fundus image” was average (28.7±15.6) words and the number of words of “treatment recommendations” was average (15.7±12.9) words. According to the doctors for analysis, the average number of words of “description of ocular fundus image” was at least (15.0±7.9) words, most (49.2±16.2) words. The average number of words of “treatment recommendations” was at least (5.6±5.0) words, most (36.4±21.3) words. Conclusion At present, the vast majority of patients receiving telophthalmology image reading service get an image report within half a day. However, the details of “description of ocular fundus image” and “treatment recommendations” in the reading reports are uneven. Therefore, further training and strengthening the management to reading doctors is needed. (Ophthalmol CHN, 2016, 25: 13-17)

Effects of topical application of prostaglandin eye drops on corneal thickness and intraocular pressure 

ZHU Xiao-min, LI Hai-jun, ZHU Xiao-yan, HE Xiang-ge, XIE Lin.

2016, 25(1):  18-22.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 005

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Objective To observe the effect of topical using of prostaglandin eye drops on the thickness of the cornea and intraocular pressure. Design Prospective comparable case-control study. Participants One hundred nineteen patients with primary open angle glaucoma. Methods Patients were randomly divided into two groups, 71 eyes in 0.004% travoprost eye drops group (Tra group) and 48 eyes in 0.15% brimonidine tartrate eye drops group (Bri group). Central corneal thickness(CCT), apex corneal thickness (Apex CT), thinnest corneal thickness(TCT) and every 2 μm distant from TCT point were assessed by Pentacam Analyzer and intraocular pressure (IOP) by Goldmann applanation tonometer was corrected at the 3 and 6 months follow up.  Main Outcome Measures Central and peripheral corneal thickness; corrected intraocular pressure. Results At the last follow up, the CCT from 555.35±36.51 μm to 549.68±36.43 μm (P<0.05), Apex CT from 553.80±36.42 μm to 549.14±36.41 μm (P<0.05), TCT from 552.11±36.29 μm to 546.15±35.87 μm (P<0.05) and similar to corneal thickness from TCT 2 μm, 4 μm and 6 μm, 8 μm (CT2 and CT4, CT6 and CT8) in Tra group (P<0.05). In the 3 months, CCT was getting thinner for average 4.63±0.62 μm after 3 months’ treatment and average 5.67±0.64 μm after 6 months’ treatment. There were no significant differences in corrected intraocular pressure(c-IOP) at the baseline and the follow up (P>0.05). And no significant statistical differences was found between corneal thickness and c-IOP in Bri-group (P>0.05).  Conclusion Topical use of prostaglandin eye drops is one of potential risk factors to make corneal thinner, despite of no effect on c-IOP.  (Ophthalmol CHN, 2016, 25: 18-22)

Long-term outcomes of ultrasound biomicroscopy in eyes with primary angle closure suspect after laser peripheral iridotomy: a five-year progression study 

LV Ai-guo1, 2, MU Da-peng3, GUO Li-xia2, LIANG Yuan-bo4, LI Si-zhen5, CUI Hong-yu2, ZHANG Zhi-hong2, FAN Su-jie2

2016, 25(1):  23-29.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 006

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 Objective To quantitatively evaluate the long-term changes in anterior segment morphology with ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure suspect (PACS). Design Prospective case series study. Participants 42 PACS consecutive patients in Handan Eye Hospital, Hebei were enrolled. Method LPI was performed in one eye selected randomly for every PACS. Routine ophthalmic tests and UBM examination were performed at presentation and 5 years after LPI. Main Outcome Measures The parameters of anterior chamber angle ahead 500 μm and 750 μm of scleral spur, such as angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) trabecular-ciliary process distance (TCPD) and iris thickness (IT) on UBM images. Results The mean follow-up period was (5.2±0.5) years in 42 patients. AOD500, AOD750, TIA500, TIA750, ARA500, and ARA750 were significantly widen at 5 years after LPI than that at presentation in eyes with PACS (all P<0.001). IT500, IT750 were significantly decreased 11% and 6% respectively at 5 years after LPI than that at presentation in eyes with PACS (all P<0.001), and the parameters at 750 μm anterior to the sclera spur were more significantly wide than its 500 μm counterpart. Conclusion LPI can significantly widen the peripheral anterior angle in eyes with PACS and this effectiveness to be sustained at least 5 years after LPI.  (Ophthalmol CHN, 2016, 25: 23-29)

Assessment of corneal biomechanical properties in glaucoma patients with corneal visualization Scheimpflug technology

TIAN Lei1, WU Ying2, HUANG Yi-fei2

2016, 25(1):  30-35.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 007

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Objective To assess the biomechanical properties of cornea in eyes with different types of glaucoma using Corvis ST. Design A prospective case control study. Participants The subjects included normal cornea volunteers and patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PAGC). Each group included 34 eyes from 34 people. Methods All subjects completed the systematic ophthalmology examination, and the corneal biomechanical measurement using Corvis ST. Comparison the differences of corneal biomechanical properties between normal eyes and eyes with POAG or PACG. The correlation relationship between deformation amplitude (DA) and age, ocular characteristics and intraocular pressure (IOP) were analyzed also. Main Outcome Measures Corneal biomechanical parameters, IOP, central corneal thickness (CCT) and corneal volume (CV). Results The normal eyes showed faster first and second applanation velocities, greater second applanation time and highest concavity peak distance in normal eyes than glaucomatous eyes. The mean value of DA was (1.07±0.10) mm in normal group, and there were (0.97±0.14) mm and (0.98±0.12) mm in POAG and PACG group, respectively. There was significant difference among the three groups (F=7.11, P=0.001), but not in POAG and PACG group. After adjusting for age, IOP, CCT and CV, DA still existed obvious difference among groups (F=40.989, P<0.001). DA and IOP showed significantly negative correlation in all three groups. Conclusion Corvis ST offers an effectively method for measuring corneal biomechanical properties. Several parameters exhibited significant differences between glaucomatous eyes and normal eyes. Compared with the normal cornea, the deformation of glaucomatous cornea was smaller, but the deformation of POAG was similar to that of the PACG. DA was obviously affected by IOP with negative correlative relationship.  (Ophthalmol CHN, 2016, 25: 30-35)

The short-term lowering intraocular pressure efficacy of travoprost for residual primary angle closure glaucoma

ZHANG Heng-li, TANG Guang-xian, YAN Xiao-wei, LI Fan, MA Li-hua, GENG Yu-lei.

2016, 25(1):  36-39.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 008

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Objective To observe the outcome of travoprost for uncontrolled intraocular pressure after antiglaucomatous surgery in patients with primary angle closure glaucoma (PACG). Design Prospective case series. Participants The PACG patients with uncontrolled-intraocular pressure after laser periphery iridotomy (5 eyes of 5 cases) and trabeculectomy (30 eyes of 26 cases) were consecutively recruited in First Hospital of Shijiazhuang City, whose 60°anterior chamber angle at least was kept in opening. Methods All patients were intervened with 0.004% travoprost once daily. The changes in intraocular pressure were monitored with Goldmann applanation  tonometer before and after management for 2 weeks, 8 weeks and 12 weeks. Mean Outcome Measures Intraocular pressure and side actions of the drug. Results The average intraocular pressure was 24.58±5.12 mmHg before intervention with travoprost. After treating for 2 weeks, 8 weeks and 12 weeks, the average intraocular pressure was 18.48±3.12 mmHg, 17.12±4.05 mmHg, and 17.05±3.98 mmHg, respectively (P＜0.001). Systemic and local severe adverse reactions were not found in 12 weeks after administration. Conclusions This short-term observation of small samples showed that travoprost can effectively and safely reduce the uncontrollable intraocular pressure for patients with uncompletely anterior chamber angle closure of PACG after anti-glaucomatous operation. (Ophthalmol CHN, 2016, 25: 36-39)

Immunosuppressive agents pulse therapy on ocular surface influences in thyroid associated ophthalmopathy

ZHOU Xiao-qing, GU Yan-hua, ZHANG Yin, MA Xiao-ye, WEI Rui-li．

2016, 25(1):  40-44.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 009

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Objective To observe the ocular surface changes of thyroid associated ophthalmopathy (TAO) before and after immunosuppressive agents pulse therapy. Design Prospective comparative case series. Participants TAO patients and normal controls, 30 cases (60 eyes) respectively. Method The group of TAO patients received methylprednisolone 0.5 g in 250 ml physiological saline and cyclophosphamide 0.2 g in 500 ml physiological saline for intravenous drop, 1 times a day, for 3 days of shock treatment. The subjects were then proceeded for clinical examinations and recorded of ocular indexes of them. Main Outcome Measures exophthalmos, palpebral fissure height, blinking, cornea fluorescein staining (FL), fluorescein break-up time (FBUT), Schirmer I test (SIT), and Ocular Surface Disease Index (OSDI) of these subjects. Results There were significant difference in every observation index of ocular surface mentioned above between normal subjects and TAO patients before immunosuppressive (all P=0.000).There were no significant difference in recorded of exophthalmos (P=0.083), palpebral fissure height (P=0.091) between TAO patients before and after immunosuppressive agents pulse therapy. After immunosuppressive agents pulse therapy, TAO patients have less blinking times (P=0.000), lower FL (P=0.001), shorter FBUT (P=0.000), longer SIT (P=0.000) and lower OSDI (P=0.000) with statistic significant differences. Conclusions The damage of ocular surface in TAO patients is obvious. The ocular surface of TAO patients can be improved by immunosuppressive agents pulse therapy, and its mechanism may be through inhibition of ocular surface inflammation and the effect of lacrimal gland first.  (Ophthalmol CHN, 2016, 25: 40-44)

Surgical methods and effect of the children's consecutive esotropia 

CAO Wen-hong, WU Qian, YU Gang, FAN Yun-wei, CUI Yan-hui.

2016, 25(1):  46-50.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 010

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Objective To investigate surgical methods and effect of the children's consecutive esotropia. Design Retrospective case series． Participants 22 patients from 4 to 11 years-old (average 7.2±2.1 years-old ) with consecutive esotropia which persisted over 6 months after exotropia surgery were analyzed retrospectively. Methods The choice of operative methods depended on the abduction impairment, angle of the difference and traction test. All surgeries were combined with adjustable suture technique. Clinical success was defined as disappeared diplopia and abnormal head position, mean deviation within ±10 PD as long term follow up. The patients were followed up for average 16.1±5.3 months. Main Outcome Measures Preoperative deviation, mobility evaluation, eye movement, and abnormal head position, binocular stereopsis and fusion were performed as well as post-operative residual deviation and binocular function. Results 8 patients less than +30 PD in primary position with abduction impairment were treated with advancement at insertion of lateral rectus muscle. 3 patients of +30~+40 PD in primary position with abduction impairment were treated with partial resection at insertion of lateral rectus muscle. 5 patients more than +40 PD in primary position with abduction impairment were treated with advancement of lateral rectus combined with recession of medial rectus; 6 patients less than +30 PD in primary position without limited abduction were treated with recession of medial rectus. At the last follow-up deviation was （-3.5±-6.4） PD. 5(22.7%) cases were suture-adjusted. All patients had no limited abduction. The success rate was 86.4% (19/22). Binocular stereopsis and fusion were significantly improved. Conclusion Surgical treatment for consecutive esotropia is effective. For abduction impairment, advancement at insertion of lateral rectus muscle should be the first choice. Postoperatively, deviation, binocular stereopsis and fusion were significantly improved. Adjustable suture technique can reduce the probability of re-operation.  (Ophthalmol CHN, 2016, 25: 46-50)

Reproducibility of parafoveal choroidal vessel layer thickness measurements with enhanced depth imaging by spectral-domain optical coherence tomography 

ZHAO Jing, WANG Ya-xing, ZHANG Qi, LI Jian-jun, XU Liang.

2016, 25(1):  51-57.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 011

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Objective To measure the inter-observer reproducibility and intra-observer reproducibility of choroidal vessel layer thickness measurements of macula measured with spectral-domain optical coherence tomography(SD-OCT). Design Prospective study. Participants 50 individuals selected randomly from the Beijing Eye Study 2011, which included 3187 individuals with a mean age of 64.0±9.6 years that choroidal vessel layer thickness can be measured. Methods The medium choroidal vessel-choriocapillaris layer and the large choroidal vessel layer were measured by two ophthalmologists with enhanced depth imaging of SD-OCT. Only the right eye of each participant was assessed and the measurements were performed at the following locations:  the fovea, 750 μm nasal to the fovea and 750 μm temporal to the fovea. The intra-class correlation coefficient (ICC) and Bland-Altman analysis were calculated. Main Outcome Measures The intra-class correlation coefficient (ICC) and Bland-Altman plot. Results The analysis of the intra-observer variability revealed an intra-class correlation coefficient( ICC) of more than 0.945 (P<0.05), thereafter, Bland-Altman plot showed less than 10.0% points outside the 95% limits of agreement. We also found an inter-observer ICC reproducibility value of more than 0.977, whereupon, Bland-Altman plot showed less than 8.0% points outside the 95% limits of agreement. Conclusion Under routine examination conditions, measurements of choroidal vessel layer thickness by SD-OCT showed almost perfect intra-observer reproducibility and inter-observer reproducibility, this procedure is suitable for clinical diagnosis and research of retinal disease.  (Ophthalmol CHN, 2016, 25: 51-57)

Clinical observation of efficacy of  intravitreal lucentis injection combined with laser treatment for multiple chronic central serous chorioretinopathy

ZHANG Lei, LIU Da-chuan, WU Hang, YANG Hui-qing.

2016, 25(1):  59-62.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 012

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Objective To observe the clinical efficacy of intravitreal lucentis injection combined with Laser treatment in the treatment of multiple chronic central serous chorioretinopathy(CSC). Design Retrospective case series. Participants 20 eyes of 13 patients with multiple CSC were enrolled. Methods All patients were confirmed by best corrected visual acuity (BCVA), fundus fluorescein anglograph (FFA) and spectral domain optical coherence tomography (SD-OCT). All the patients were treated with an intravitreal injection of lucentis, 4 weeks after injection, laser treatment were performed. Patients had follow-up on 4,8,12 weeks after all the treatment. Main Outcome Measures included pre and post treatment changes in BCVA, FFA and subretinal fluid (SRF). Results 4 weeks after the lucentis injection, the nerve epithelium or pigment epithelium detachment was significantly improved in all eyes. All of the patients BCVA were significantly improved (from 0.47±0.24 to 0.70±0.16, P=0.042). The SRF was (445±134) μm before treatment, and it was (182±101) μm after intravitreal lucentis injection treatment 4 weeks. The SRF was (59±11) μm (P=0.004) after 8 weeks combined treatment. The SRF of parafoveal was (409±112) μm before treatment, after 4 weeks lucentis treatment it was (142±87) μm and the SRF was (50±15) μm after 8 weeks combined treatment. The FFA showed no abnormal leakage 12 weeks after all treated. Conclusion Intravitreal lucentis injection combined with laser treatment of multiple CSC has curative effect. Intravitreal lucentis injection treatment can work on leakage points, at the same time, promote the retinal neuroepithelium and pigment epithelium under liquid absorption, shorten the treatment time, improve patients' BCVA, and reduce the retinal damage by laser treatment.  (Ophthalmol CHN, 2016, 25: 59-62)

Study on human visual fatigue induced by watching linear polarized liquid crystal display and circular polarized liquid crystal display with eye tracker 

ZHANG Li1, XU Liang1, ZHANG Yun-hong2, LI Jian-jun1.

2016, 25(1):  63-67.  doi:10.13281/j.cnki.issn.1004-4469.2016.01.013

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Objective To explore the different effects on human visual fatigue induced by watching linear polarized liquid crystal display(LCD) and circular polarized using eye movement analysis. Design Experimental study. Participants 60 healthy young subjects whose refractive status are emmetropia. Methods 60 subjects were divided into two groups randomly. Two groups were arranged to view linear polarized LCD and circular polarized LCD respectively, blinking frequency and blink duration time were recorded using eye tracker. Main Outcome Measures The real time eye movement parameters blink frequency and blink duration time. Results While viewing the video, blink frequency and blink duration time of two groups decreased at first and then increased till the end. Blink frequency of the linear polarized group decreased to 13.95 times/min from the original 15.83 times/min, blink frequency of the circular polarized group decreased to 11.46 times/min from the original 13.93 times/min. Blind frequency of two groups increased at the latter period because of visual fatigue, blink frequency of the linear polarized was 22.63 times/min at the end of stage, and blink frequency of the circular polarized group was 16.33 times/min. Blink duration time of the linear polarized group ranged from 2272 milliseconds/min at the beginning to 4084 milliseconds/min at the end of stage. Blink duration time of the circular polarized group ranged from 2001 milliseconds/min at the beginning to 2596 milliseconds/min at the end of stage. The changes of blink frequency and blink duration time before and after viewing the video in two groups was statistically significant with P value 0.030 and 0.031 respectively. Conclusion While viewing video, blink frequency and blink duration time of two groups decrease at first and then increase in the overall trend, the changes of blink frequency and blink duration time of the linear polarized group were significantly higher than those of the circular polarized group. Circular polarized LCD causes less visual fatigue. (Ophthalmol CHN, 2016, 25: 63-67)

Necessary of clinical training in neurology department of ophthalmologists

JIANG Han-qiu1, ZHANG Xiao-jun1, LIU Li-juan2, WANG Jia-wei1.

2016, 25(1):  68-70.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 014

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The neuro-ophthalmology is an interdisciplinary of neurology and ophthalmology, and it is the edge subject that doctors of ophthalmology and neurology both focus on in recent years. More and more ophthalmologists realized that strengthen the understanding of neuro-ophthalmology diseases could help them to diagnose and identify many ophthalmology diseases. Thus, Department of Neurology in Beijing Tongren Hospital enrolled 33 ophthalmologists of different levels for neurology residency training.  Follow studying in neurology department, the level of diagnosis and treatment for neuro-ophthalmology were significantly improved in the ophthalmologists.  (Ophthalmol CHN, 2016, 25: 68-70)

The best way to teach the last lesson of ophthalmology

LI Na, LI Kun.

2016, 25(1):  70-71.  doi:10. 13281/j. cnki. issn.1004-4469. 2016. 01. 015

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Ocular disorders associated with systemic diseases is the last lesson of ophthalmologic teaching process for the undergraduate, which contains a large number of contents. In the section, the inductive-contrastive method, elicitation method and the method of learning the new by restudying the old are used together with multimedia approach. These methods can enhance the study interest and initiative of students, and enable them to be well versed in ophthalmology. Teaching this chapter well is of paramount importance to the improvement of the teaching quality.  (Ophthalmol CHN, 2016, 25: 70-71)